Surgery (Austin & Northern Health) - Theses
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ItemPopulation-based studies In urologic cancer( 2019)Introduction Long-term data on cancer outcomes are frequently based on large series from single- or multi-institutional databases, and whilst study numbers may be large, the study population and outcomes are often not truly reflective of community practice. Furthermore, very few of these studies, especially in urologic oncology, include patients diagnosed and treated in Australia. Using a population-based cancer registry, we sought to evaluate long-term survival outcomes in men with prostate cancer treated with surgery in Victoria, and identify the clinicopathologic and sociodemographic factors that influenced survival. Furthermore, we sought to evaluate the practice patterns of management of renal cell carcinoma (RCC) in Victoria, and identify potential differences in management between metropolitan and regional areas. Methods All eligible cases were identified from the Victorian Cancer Registry (VCR). There is a statutory requirement that all diagnoses of invasive cancer, excluding non-melanoma skin cancer, be reported to the VCR. The Victorian Radical Prostatectomy Register (VRPR) is a whole of population series of men who underwent radical prostatectomy for the treatment of prostate cancer between 1995 and 2000 in Victoria. Eligible cases were identified from the VCR and relevant clinicopathologic data was obtained via medical record review. Follow-up PSA and death data were obtained via record-linkage to pathology laboratories and the Victorian Registry of Births, Deaths and Marriages. All cases of RCC diagnosed in Victoria between 1 January 2009 and 31 December 2009 and registered with the VCR were identified. Trained data managers extracted relevant data by retrospective review of medical records and pathology reports. Data extracted included: mode of presentation, diagnostic and staging investigations, clinical and pathological disease stage, socioeconomic data, first line treatment, enrolment in clinical trials, and provision of multidisciplinary care. Case residency was categorised as metropolitan or regional/rural based on the Department of Human Services Integrated Cancer Services regions. Results Between 1995-2000, 2154 men underwent radical prostatectomy in Victoria. During a median follow-up of 10.2 years, 74 men died from prostate cancer. In addition to Gleason score and pathological stage, symptomatic presentation was associated with increased prostate cancer-specific mortality (PCSM). After adjusting for stage and PSA, no difference in PCSM was found between men with Gleason = 6 and Gleason 3+4 = 7 (p=0.649). Men with Gleason 4+3 had significantly greater cumulative incidence of PCSM compared to men with Gleason 3+4 (SHR = 2.79, 95% CI 1.40 – 5.54, p = 0.003). 695 men experienced biochemical recurrence during follow-up, of which 82% occurred within 5 years of radical prostatectomy. Men with combined high Gleason sum (>4+3) and extra-prostatic (>pT3a) disease had substantially increased mortality rate with early biochemical recurrence (BCR), while those experiencing BCR after a longer interval had significantly lower mortality. Men with combined low Gleason sum (<3+4) and organ-confined disease (